There are lots of ways to skin a cat. (Just a SAYING.  We don't even eat our
chickens.  When they get old and die, we bury them!)  Anyway, the issue to me
isn't so much can you get food into a baby via spoon, cup, dropper,
finger-feeding w/ syringe, feeding tube or bottle.  It's clear that you can,
and throughout human history people have.  There is (or was) a very
instructive display of archeological artifacts at the Children's Nutrition
Research Center in Houston.  All of them were infant feeding implements of
one sort or another dug up from pyramids, mounds, tombs etc.  The question I
have is:  Is there one way or another that is preferable if the infant is
temporarily prevented from breastfeeding?

I have seen plenty of babies who I have managed with finger feeding become
just as 'nipple confused' as babies who have been getting bottles.  A long,
formed object was in both cases being pushed (rather than pulled) into baby's
mouth, and milk was then delivered.  I've had babies with strong sucks pull
the milk out of a periodontal syringe without my pushing on it.  But what is
the difference between that and their sucking the milk out of a nipple
chamber?  Is there a difference? Neither is like breastfeeding.  Now, don't
consider this a rationalization for using bottles.  Just a desire to initate
a discussion.

I still finger feed some babies.  I also cup or spoon feed.  Some I bottle
feed. It depends on the baby's problem, the parents desire and willingness to
learn a method, and how much time we have to play with.   Cups and spoons
don't present the problem of conditioning baby to expect a formed object to
be pushed back far enough to trigger a palatal cue to suck.  However, I can't
consider them  some sort of holy grail solution.  For instance, there have
been a few lactnet posts describing babies who never had bottles, only cup
and still wouldn't go to breast.  That has certainly happened to some of the
babies I've used cup feeding with.( Generally I then resort to a silicone
nipple shield and gradually wean off it.) Cups are just one more way you can
try to get food into a non-nursing baby.  I would really like to see cup
feeding not become the new dogma.  I think hospt. policies should focus on
inclusion of cup feeding. Pardee's post was useful there.  I don't think that
everyone should now decide that cup feeding is somehow the only pc
(politically correct) way to alternatively feed.  For one thing, I am not
aware of any large body of clinical work that supports any method of
alternative feeding as measurably better or worse in terms of how successful
it is in preserving breastfeeding. (There is work, of course, describing
adverse effects of early bottle initiation. There is also at least one paper
that describes early bottle use as not particularly a problem, although this
was occasional use  in well babies -- not the population I am considering.
That ref is: Cronwett, et al:  Single Daily Bottle Use in the Early Weeks
Postpartum and Breastfeeding Outcomes.  Pediatrics, 1992; 90(5):760-66.)  I
would be interested in hearing if anyone knows of work that goes beyond HOW
to alternatively feed. Specifically I am interested in outcomes:  adverse as
well as beneficial.

I'd like to see some of our research oriented lactnetters consider soliciting
data from those of us in clinical practice about outcomes from interventions
involving different alternative feeding methods.  Obviously there would need
to be some sort of design that allowed for confounding variables to be sorted
out, but between all of the babies we see, perhaps we could begin to gather
some info.that would help us develop rationales for selecting the most
appropriate feeding method for babies in various situations.  For instance,
one of my pet theories is that if mother has inverted nipples, her baby esp.
should be managed without exposure to bottle teats.  This is a set-up for
breast refusal.  I'd probably also avoid finger-feeding this baby as well.

Can you tell that I have a 3 day weekend and time on my hands, or what?

Happy New Years to All!
Barbara Wilson-Clay, BSE, IBCLC
priv. pract. Austin, Tx